Defining and Evaluating Norms for Health and Social Service (HASS) Use

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Background In view of expected growth of the older population in Singapore in the next decades, the volume and complexity of needs for health care services is expected to increase, which amplifies stress on the current healthcare system. One approach to addressing this challenge is to consider service utilization in relationship to needs based on "population segmentation" and to plan and evaluate new services in light of unmet needs.

Specific Aims and Hypotheses Primary Aim 1: To establish health and social service (HASS) norms for population segments as defined by the Simple Segmentation Tool (SST) via a modified-Delphi methodology.

Primary Aim 2: To evaluate the concordance between the types of HASS that patients in each population segment actually utilize versus the types of HASS normatively defined for each population segment over a 3-month period from the point of hospital discharge.

Primary Hypothesis: The concordance between the actual utilization of different types of HASS versus normative HASS is not better than fair.

Secondary Aim: To assess the association between concordance of normative HASS and incidence of adverse outcomes which includes emergency department visits, unplanned hospital readmissions, nursing home placement, and all-cause mortality over a 12-month period from point of hospital discharge for all population segments.

Secondary Hypothesis: Patients with disagreement between normative HASS and actual utilization of HASS will have a higher incidence of adverse outcomes.

Methodology The investigators will use a modified-Delphi methodology to develop HASS norms and conduct a follow-up study of inpatients to evaluate the concordance between the types of HASS utilized and norm HASS, and to evaluate the association between this concordance and adverse outcomes in each population segment.

Significance to Health Services Delivery The transformation of the health care system to effectively meet growing needs in a patient-centric way requires practical tools for population planning and program development. The norms and evaluation approaches developed here will guide clinical and public policy decision makers in prioritizing population needs, and thus contribute to tangible improvements in health services delivery, patient care and health outcomes for an aging Singapore population.

Health and social service (HASS) norms for population segments [ Time Frame: 5 months ]

HASS norms for population segments as defined by the Simple Segmentation Tool (SST) will be established via a modified-Delphi methodology analogous to that used in the RAND Appropriateness Initiative. The exercise will consist of two rounds of rating - an independent rating round and a group meeting to reconcile the results.

The value of each indication by circling a number from 1 to 9 (1 being definitely not high value and 9 being definitely high value). The median panel rating to identify agreement or disagreement for each indication. Agreement is reached when 2 or fewer panel members vote outside the 3-point region containing the median. Disagreement is determined when 3 or more panelists rated in each extreme (1-3 and 7-9).

Concordance between actual HASS utilization vs HASS norms [ Time Frame: Over a 3-month period from date of discharge ]

Information on the types of HASS that patients in each population segment actually utilize will be compared against the types of HASS normatively defined for each population segment over a 3-month period from the point of hospital discharge to evaluate concordance between the two. Type of services, frequency of utilization, reasons for taking and not taking the prescribed services, service expenditure, and adverse outcomes will be collected.

Secondary Outcome Measures
:

Association between concordance of normative HASS and incidence of adverse outcomes over a 12-month period from point of hospital discharge for all population segments. [ Time Frame: Over a 12-month period from date of discharge ]

Adverse outcomes for the purpose of this study include emergency department visits, unplanned hospital readmissions, nursing home placement, and all-cause mortality. The association will be assessed by review of information from EMR, National Death Registry, MOH and survey results. The associated healthcare expenditure will be estimated to understand the economic burden of study participants.

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Ages Eligible for Study:

55 Years to 100 Years (Adult, Senior)

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

Sampling Method:

Non-Probability Sample

Study Population

Study participants will be recruited from inpatients in the Singapore General Hospital Department of Internal Medicine (SGH DIM) and categorized based on their health care needs using the SST.